Abstract
Background Asthma symptoms adversely impact quality of life in particular in those with poor disease control. Commonly used patient reported measures for asthma used to assess asthma control often inadequately capture the impact of cough, despite evidence that cough is one of the most bothersome symptoms for patients with asthma. This study aims to improve our understanding of how patients with asthma perceive cough to better understand its clinical impact.
Methods A discrete choice experiment (DCE) was performed in two distinct adult asthma populations; those with severe asthma as defined by GINA step 4/5 classification and those with moderate asthma (a GINA steps 2 or 3 classification of asthma severity).
Results Choices were highly dominated by the cough attribute in the symptoms complexes; 48.4% of patients with severe asthma and 31.3% with moderate asthma consistently chose the alternative with the lowest level of cough. Furthermore, cough predominance was found to be significantly associated with severity of asthma (p=0.047). Patients with moderate asthma were not willing to accept any additional symptoms to reduce cough from severe to mild. However, these patients were willing to accept mild breathlessness, mild sleep disturbance, severe chest tightness and severe wheezing to remove coughing altogether.
Conclusions Patients with asthma prefer to have less cough and are willing to accept greater levels of other symptoms to achieve this. Additionally, asthma severity may influence an individual's perception of their symptoms; cough is a more important symptom for patients with severe asthma than those with a milder disease.
Footnotes
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Conflict of interest: Joshua Holmes has no conflict of interest to declare
Conflict of interest: Vikki O'Neill has no conflict of interest to declare
Conflict of interest: Lorcan P McGarvey has received grants and personal fees from Afferent Pharmaceuticals and Merck Sharp & Dohme; personal fees from Applied Clinical Intelligence; grants from Asthma UK, Northern Ireland Chest Heart and Stroke, NC3Rs, British Heart Foundation, and Chiesi; travel and subsistence for attendance at scientific meetings from Boehringer Ingelheim, GlaxoSmithKline, and Chiesi; and advisory board or consultancy fees from Almirall, NAPP, GlaxoSmithKline, and Boehringer Ingelheim.
Conflict of interest: Liam G. Heaney has received grant funding, participated in advisory boards and given lectures at meetings supported by Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Hoffmann la Roche, GlaxoSmithKline, Novartis, Theravance, Evelo Biosciences, Sanofi, and Teva; he has received grants from MedImmune, Novartis UK, Roche/Genentech Inc, and Glaxo Smith Kline, Amgen, Genentech/Hoffman la Roche, Astra Zeneca, MedImmune, Glaxo Smith Kline, Aerocrine and Vitalograph; he has received sponsorship for attending international scientific meetings from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK and Napp Pharmaceuticals; he has also taken part in asthma clinical trials sponsored by AstraZeneca, Boehringer Ingelheim, Hoffmann la Roche, and GlaxoSmithKline for which his institution received remuneration; he is the Academic Lead for the Medical Research Council Stratified Medicine UK Consortium in Severe Asthma which involves industrial partnerships with a number of pharmaceutical companies including Amgen, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Hoffmann la Roche, and Janssen
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- Received August 30, 2022.
- Accepted October 6, 2022.
- Copyright ©The authors 2022
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